Most of the pregnant women suffer form swollen up and bleeding gum. Clinically the gingiva of the pregnant women is characterised by inflammatory changes.

There may be collection of fluid in the gum; it may be hyperplastic and dark red. There is a tendency of bleeding when brushing teeth or chewing food.

Evidences suggested that local and hormonal factors play the main role. There seems to be a strong correlation between the severity of gingival inflammation and the rise of gonadotropin (a hormone) production during the first trimester.

During the second and third trimester the gingival response corresponds to an increase in the concentration of estrogen (a sex hormone), progesterone and relaxine.

However, research data seems to support the theory that local irritants are the initiating factors in precipitating gingival inflammation.

Oral and dental health During pregnancy
Oral health during pregnancy has long been a focus of interest. Hormonal effects result 25 to 100 per cent gingivitis in western society. 10 per cent develop pyogenic granuloma or pregnancy epulis (a tumour). 95 per cent pregnant women suffers from gingivitis in Bangladesh community.

Causative factors
Dental Plaque, calculus etc. act as a precipitating factor for initiation of gingivitis. Alteration in progesterone and estrogen levels effect the immune system, rate and pattern of collagen production in gingiva and reduce body's ability to repair and maintain gingival tissue. Periodontal infections can be a reservoir for inflammatory mediators. They may pose a potential threat to fetus (baby in the womb). They increase the likelihood of pre-term delivery.

Periodontal infection and pre-term birth (PTD)
PTD is the major cause of neonatal mortality. PTD tolls the chance of long term neurological morbidity to 50 per cent. Pre-existing periodontal disease in the second trimester of pregnancy increases the risk of pre term birth. There is a significant association between PTD and periodontitis at 21 to 24 weeks gestation.

Treatment of periodontitis will reduce the chances of PTD. Best advice to pregnant women is to prevent periodontal disease by-

(i) At least two times dental visits during pregnancy.

(ii) Removal of potential source of infection e.g. dental plaque and calculus.

Dental check up is an integral part of antenatal cheek up during pregnancy and it should be followed strictly.

Dr Md Mujibur Rahman Howlader, FCPS (Cons), MS, DDS, BDS, is an Assistant Professor of Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, BSMMU, Dhaka.